title: Long-term hepatic outcomes in survivors of stage 4S and 4 neuroblastoma in infancy.
abstract: BACKGROUND
  Infants with stage 4 and 4S neuroblastoma (NB) have a superior prognosis to older children. However, they often require intensive therapy including abdominal radiation. We aimed to investigate the long-term hepatic outcomes in infants with stage 4S and 4 NB.
  
  
  METHODS
  We reviewed the charts of 38 infants diagnosed with stage 4S and 4 NB between 1984 and 2002. We included only those with available follow-up 5 years following diagnosis. We assessed hepatic imaging and function (transaminases, bilirubin, alkaline phosphatase) at all available time points from diagnosis. Abnormalities present at more than 5 years from diagnosis were considered persistent late changes.
  
  
  RESULTS
  We identified 15 stage 4S and 12 stage 4 patients. Twelve of 15 stage 4S patients had hepatic involvement at diagnosis, 8 of whom required abdominal radiation. Five of eight demonstrated late imaging changes. Two of four with hepatic metastases but no radiation demonstrated late imaging changes. The late imaging changes resolved over time and without intervention in 3/7 survivors. The persistent lesions included liver fibrosis (1) and focal nodular hyperplasia (FNH) (3). Five of 12 stage 4 NB patients had hepatic involvement at diagnosis; none required radiation or had late hepatic imaging changes.
  
  
  CONCLUSIONS
  In stage 4S NB, adverse hepatic effects are infrequent, may resolve over time, and occur with or without radiation. FNH should be considered in those with persistent late imaging changes. Adverse hepatic outcomes after liver involvement or radiation in infants with stage 4 NB rarely occur.
authors.affiliation: Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. amy.french@utoronto.ca
authors.forename: Amy E
authors.initials: AE
authors.lastname: French
authors.forename: Meredith S
authors.initials: MS
authors.lastname: Irwin
authors.forename: Oscar M
authors.initials: OM
authors.lastname: Navarro
authors.forename: Mark
authors.initials: M
authors.lastname: Greenberg
authors.forename: Paul C
authors.initials: PC
authors.lastname: Nathan
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008107:Liver Diseases / Q000209:etiology* / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D009367:Neoplasm Staging; D009447:Neuroblastoma / Q000150:complications* / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors